Protein-Energy Malnutrition: Causes, Symptoms, Treatment, Prevention, Diet Plan

Protein-Energy Malnutrition (PEM) is a condition, most commonly occurring in infants, who are deprived of the essential nutrients, resulting in several clinical problems. Protein-Energy Malnutrition (PEM) is most often seen in developing countries. It is important to understand the causes, symptoms, treatment, prevention and diet plan of protein-energy malnutrition to be able to control the condition.

What is Protein-Energy Malnutrition?

What is Protein-Energy Malnutrition?

When growth retardation is the main manifestation detected in the patient, it is known as protein-energy malnutrition or PEM. This condition passes through various clinical stages, presents with many symptoms and the severity of Protein-Energy Malnutrition (PEM) varies from one child to another. Protein-Energy Malnutrition (PEM) mainly occurs in infants who are born in malnourished backgrounds, being weaned and pre-school children in most developing nations all over the globe.

There are many causes of protein-energy malnutrition and the symptoms too vary. Treatment of Protein-Energy Malnutrition (PEM) mainly depends on correcting the cause and providing proper nourishment to control malnutrition.

Causes of Protein-Energy Malnutrition

The major causes of protein-energy malnutrition include

  • Economic and Social Factors – One of the major and most common causes of Protein-Energy Malnutrition (PEM) are the economic and social factors which affect several poor people in most developing countries. Extreme poverty causes unhygienic living conditions, limited availability of food and no or very little child care; all of which result in Protein-Energy Malnutrition (PEM). Reduced breast feeding and poor weaning practices are also some of the contributing causes of Protein-Energy Malnutrition (PEM).
  • Environmental Factors – There are several environmental factors that can also lead to Protein-Energy Malnutrition (PEM). Infections such as diarrhea often develop due to unsanitary conditions while other factors such as floods, earthquakes, drought and improper agricultural patterns lead to scarcity of food. Inadequate storage conditions can also aggravate the problem. Gastrointestinal condition and other infections resulting from poor sanitation, are one of the commonest cause of protein-energy malnutrition among infants and young children.
  • Age – As infants and young children grow their nutritional requirements also increase quite rapidly. When this requirement is not met properly, it often becomes one of the causes of protein-energy malnutrition which is most common in infants and children below 18 months of age. Poor families with more number of children are unable to meet the nutritional demands of growing children, resulting in malnutrition and causing Protein-Energy Malnutrition (PEM).
  • Biological Factors – If a woman undergoes maternal malnutrition both during her pregnancy and before it, chances are that she will give birth to a weak and underweight baby who will also be malnourished. Infectious diseases such as measles and diarrhea which are commonly prevalent in developing countries also cause a negative energy and protein balance in the body and can cause protein-energy malnutrition.

Symptoms of Protein-Energy Malnutrition

There are several forms of Protein-Energy Malnutrition (PEM) which can affect a child or an infant. The symptoms of protein-energy malnutrition depend on the form which has affected the child. The different symptoms for different forms are mentioned below:

  • Kwashiorkor – The common symptoms in this form of Protein-Energy Malnutrition (PEM) is failure in growth, mental changes, wasting of muscles. The feet along with the lower legs experience edema which soon affects the face, thighs and hands too. Other symptoms include a fatty and enlarged liver, moon face, appetite lossdiarrhea and vomiting. Changes in hair, anemia and characteristic changes in the skin are also associated symptoms of protein-energy malnutrition.
  • Marasmus – In this form, common symptoms of Protein-Energy Malnutrition (PEM) include extreme retardation of growth, loss of fat from the body and excess wasting of muscles. The body looks shriveled, wrinkled and bones become visible.
  • Marasmic Kwashiorkor – In this form, the features and symptoms of both Kwashiorkor and Marasmus are noticed in the patient suffering from protein-energy malnutrition.
  • Underweight – Children suffering from this form of Protein-Energy Malnutrition (PEM) are below normal as far as their weight for both age and height is concerned. Also, such children are at a greater risk for gastric and respiratory infection.
  • Stunting – Also known as nutritional dwarfing, the child shows symptoms of protein-energy malnutrition, as reduced height and weight thereby looking normal though they aren’t so.

Treatment of Protein-Energy Malnutrition

The treatment plan for protein-energy malnutrition can be divided in three main stages which include:

  • Hospitalization – If the child affected by Protein-Energy Malnutrition (PEM) is also suffering from severe conditions such as hypoglycemia, dehydration, infection, hypothermia, anemia, vitamin or mineral deficiency and electrolyte imbalance, hospitalization is required. Treatment of Protein-Energy Malnutrition (PEM) in this case is based on the complaints and is aimed at treating the cause, improving the symptoms and restoring energy.
  • Restoring Nutritional Status – At this stage, the treatment of Protein-Energy Malnutrition (PEM) includes giving locally available and affordable food items which digest easily. They must be well distributed throughout the day to restore the nutritional status quickly and effectively. The number of feedings to the child are gradually increased along with improvised food quality.
  • Rehabilitation – Nutritional rehabilitation, a main part of treatment of protein-energy malnutrition, is achieved by giving practical training to the mother of the patient. During this training, she is taught how to feed her child with local and nutritious food items and bring back good health.

Prevention of Protein-Energy Malnutrition

The following measures can help in the prevention of protein-energy malnutrition to a large extent and allow the infant or pre-school child to grow up in a healthy manner.

  • Promoting breast feeding
  • Educating the mother about nutrition and correct feeding practice
  • Developing low cost weaning
  • Fortification of food
  • Proper immunization of the infant from time to time
  • Early diagnoses and appropriate treatment
  • Emphasizing on the importance of family planning and spacing between births

Diet Plan for Protein-Energy Malnutrition

One of the major aspects of a correct diet plan for protein-energy malnutrition is to include macronutrients in the child’s diet. An optimum choice of treatment is the inclusion of milk-based formulas which help provide both proteins and sufficient energy to the child or infant suffering from Protein-Energy Malnutrition (PEM). Doctors usually advice giving ad libitum to the patient during the beginning of the dietary treatment and within 7 days, the rate for children should reach an approx. of 4g/kg of protein and 175 kcal/kg. In case of adults, it should be 2g/kg of protein along with 60kcal/kg. It is absolutely essential to add a daily multivitamin along with the diet for quick recovery from Protein-Energy Malnutrition (PEM).


Protein-energy malnutrition, though extremely common, can be easily controlled and reversed with the right guidance and knowledge. Educating the parents, especially the mothers, helps to overcome the malnutrition and gradually make the child or infant healthy once again. Also, early intervention can help prevent such malnutrition and ensure that the child gets nutritious and healthy food items especially during the growth years.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:May 29, 2017

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